MDS FULL ASSESSMENT FORM: -: PT: ^PATIENT: -:

45981-8 MDS FULL ASSESSMENT FORM: -: PT: ^PATIENT: -:

NAME

Component Property Time System Scale Method

MDS FULL ASSESSMENT FORM - PT ^PATIENT -

BASIC PROPERTIES

Class/Type: PANEL.SURVEY.MDS/Survey Order vs. Obs.: ORDER

Units Required: N

PANEL CHILDREN

LOINC Component Property Time System Scale Method R/O Datatype Submitters Code 45981-8 MDS FULL ASSESSMENT FORM - PT ^PATIENT -

45982-6 IDENTIFICATION AND BACKGROUND INFORMATION SECTION

- PT ^PATIENT -

45965-1 NAME - PT ^PATIENT SET

45394-4 LAST NAME PN PT ^PATIENT NOM TX AA1c

45395-1 NAME SUFFIX PN PT ^PATIENT NOM TX AA1d

45392-8 FIRST NAME PN PT ^PATIENT NOM TX AA1a

45393-6 MIDDLE INITIAL ID PT ^PATIENT NOM MDS TX AA1b

45403-3 ROOM NUMBER LOC PT ^PATIENT NOM TX A2

45983-4 ASSESMENT REFERENCE DATE - PT ^PATIENT SET 45453-8 DATE OF LAST DAY OF

OBSERVATION PERIOD

TMSTP PT ^PATIENT QN MDS DT A3a

45454-6 ORIGINAL OR CORRECTED COPY OF FORM

NUM PT ^PATIENT ORD MDS NM A3b

45455-3 DATE OF REENTRY TO FACILITY

TMSTP PT ^PATIENT QN MDS DT A4a

45404-1 MARITAL STATUS TYPE PT ^PATIENT NOM CE A5

46106-1 MEDICAL RECORD NO. ID PT ^PATIENT NAR MDS 45984-2 CURRENT PAYMENT SOURCES

FOR NURSING HOME STAY

- PT ^PATIENT SET

45456-1 MEDICAID PER DIEM FIND PT ^PATIENT ORD MDS CE A7a 45457-9 MEDICARE PER DIEM FIND PT ^PATIENT ORD MDS CE A7b 45458-7 MEDICARE ANCILLARY PART A

PAYMENT

FIND PT ^PATIENT ORD MDS CE A7c

45459-5 MEDICARE ANCILLARY PART B PAYMENT

FIND PT ^PATIENT ORD MDS CE A7d

45460-3 CHAMPUS PER DIEM FIND PT ^PATIENT ORD MDS CE A7e 45461-1 VA PER DIEM FIND PT ^PATIENT ORD MDS CE A7f 45462-9 SELF OR FAMILY PAYS FOR

FULL PER DIEM

FIND PT ^PATIENT ORD MDS CE A7g

45463-7 MEDICAID RESIDENT LIABILITY OR MEDICARE COPAYMENT

FIND PT ^PATIENT ORD MDS CE A7h

45464-5 PRIVATE INSURANCE PER DIEM FIND PT ^PATIENT ORD MDS CE A7i 45465-2 OTHER PER DIEM FIND PT ^PATIENT ORD MDS CE A7j 45968-5 REASON FOR ASSESSMENT - PT ^PATIENT SET

45408-2 REASON FOR

ASSESSMENT.PRIMARY

FIND PT ^PATIENT NOM MDS CE AA8a

45409-0 REASON FOR

ASSESSMENT.SPECIAL

FIND PT ^PATIENT NOM MDS CE AA8b

45985-9 RESPONSIBILITY &OR LEGAL GUARDIAN

- PT ^PATIENT SET

45466-0 LEGAL GUARDIAN FIND PT ^PATIENT ORD MDS CE A9a 45467-8 OTHER LEGAL OVERSIGHT FIND PT ^PATIENT ORD MDS CE A9b 45468-6 HEALTH CARE DURABLE

POWER ATTORNEY

FIND PT ^PATIENT ORD MDS CE A9c

45469-4 FINANCIAL DURABLE POWER ATTORNEY

FIND PT ^PATIENT ORD MDS CE A9d

45470-2 FAMILY MEMBER RESPONSIBLE FIND PT ^PATIENT ORD MDS CE A9e 45471-0 PATIENT RESPONSIBLE FOR

SELF

FIND PT ^PATIENT ORD MDS CE A9f

45472-8 RESPONSIBILITY - NONE OF ABOVE

FIND PT ^PATIENT ORD MDS CE A9g

45986-7 ADVANCE DIRECTIVES - PT ^PATIENT SET

45473-6 ADVANCE DIRECTIVE - LIVING WILL

FIND PT ^PATIENT ORD MDS CE A10a

45474-4 ADVANCE DIRECTIVE - DO NOT RESUSCITATE

FIND PT ^PATIENT ORD MDS CE A10b

45475-1 ADVANCE DIRECTIVE - DO NOT HOSPITALIZE

FIND PT ^PATIENT ORD MDS CE A10c

45476-9 ADVANCE DIRECTIVE - ORGAN DONATION

FIND PT ^PATIENT ORD MDS CE A10d

45477-7 ADVANCE DIRECTIVE - AUTOPSY REQUEST

FIND PT ^PATIENT ORD MDS CE A10e

45478-5 ADVANCE DIRECTIVE - FEEDING RESTRICTIONS

FIND PT ^PATIENT ORD MDS CE A10f

45479-3 ADVANCE DIRECTIVE - MEDICATION RESTRICTION

FIND PT ^PATIENT ORD MDS CE A10g

45480-1 ADVANCE DIRECTIVE - OTHER TREATMENT RESTRICTION

FIND PT ^PATIENT ORD MDS CE A10h

45481-9 ADVANCE DIRECTIVE - NONE FIND PT ^PATIENT ORD MDS CE A10i 45987-5 COGNITIVE PATTERNS SECTION - PT ^PATIENT -

45482-7 COMATOSE FIND PT ^PATIENT ORD MDS CE B1

45988-3 MEMORY - PT ^PATIENT SET

45483-5 SHORT-TERM MEMORY OK FIND PT ^PATIENT NOM MDS CE B2a 45484-3 LONG-TERM MEMORY OK FIND PT ^PATIENT NOM MDS CE B2b 45989-1 MEMORY RECALL &OR ABILITY - PT ^PATIENT SET

45485-0 CAN RECALL CURRENT SEASON FIND PT ^PATIENT ORD MDS CE B3a 45486-8 CAN RECALL LOCATION OF

OWN ROOM

FIND PT ^PATIENT ORD MDS CE B3b

45487-6 CAN RECALL STAFF NAMES &

OR FACES

FIND PT ^PATIENT ORD MDS CE B3c

45488-4 CAN RECALL THAT HE/SHE IN NURSING HOME

FIND PT ^PATIENT ORD MDS CE B3d

45489-2 MEMORY/RECALL - NONE OF ABOVE

FIND PT ^PATIENT ORD MDS CE B3e

45490-0 MAKES DECISIONS REGARDING TASKS OF DAILY LIFE

FIND PT ^PATIENT NOM MDS CE B4

45990-9 INDICATORS OF DELIRIUM - PERIODIC DISORDED THINKING OR AWARENESS

- PT ^PATIENT SET

45491-8 EASILY DISTRACTED FIND PT ^PATIENT ORD MDS CE B5a 45492-6 PERIODS OF ALTERED

PERCEPTION OR AWARENESS OF SURROUNDINGS

FIND PT ^PATIENT ORD MDS CE B5b

45493-4 EPISODES OF DISORGANIZED SPEECH

FIND PT ^PATIENT ORD MDS CE B5c

45494-2 PERIODS OF RESTLESSNESS FIND PT ^PATIENT ORD MDS CE B5d 45495-9 PERIODS OF LETHARGY FIND PT ^PATIENT ORD MDS CE B5e 45496-7 MENTAL FUNCTION VARIES

DURING DAY

FIND PT ^PATIENT ORD MDS CE B5f

45497-5 CHANGE IN COGNITIVE STATUS FIND PT ^PATIENT NOM MDS CE B6 45991-7 COMMUNICATION AND

HEARING PATTERNS SECTION

- PT ^PATIENT -

45498-3 HEARING FIND PT ^PATIENT NOM MDS CE C1

45992-5 COMMUNICATION DEVICES AND TECHNIQUES

- PT ^PATIENT SET

45499-1 HEARING AID PRESENT & USED FIND PT ^PATIENT ORD MDS CE C2a 45500-6 HEARING AID PRESENT & NOT

USED REGULARLY

FIND PT ^PATIENT ORD MDS CE C2b

45501-4 OTHER RECEPTIVE

COMMUNICATION TECHNIQUES USED

FIND PT ^PATIENT ORD MDS CE C2c

45502-2 NO COMMUNICATION DEVICE FIND PT ^PATIENT ORD MDS CE C2d 45993-3 MODES OF EXPRESSION - PT ^PATIENT SET

45503-0 USES SPEECH FIND PT ^PATIENT ORD MDS CE C3a 45504-8 USES WRITTEN MESSAGES FIND PT ^PATIENT ORD MDS CE C3b 45505-5 USES AMERICAN SIGN

LANGUAGE OR BRAILLE

FIND PT ^PATIENT ORD MDS CE C3c

45506-3 USES SIGNS/GESTURES/SOUNDS FIND PT ^PATIENT ORD MDS CE C3d 45507-1 USES COMMUNICATION BOARD FIND PT ^PATIENT ORD MDS CE C3e 45508-9 USES OTHER MODES OF

EXPRESSION

FIND PT ^PATIENT ORD MDS CE C3f

45509-7 MODES OF EXPRESSION - NONE OF ABOVE

FIND PT ^PATIENT ORD MDS CE C3g

45510-5 MAKING SELF UNDERSTOOD FIND PT ^PATIENT ORD MDS CE C4

45511-3 SPEECH CLARITY FIND PT ^PATIENT NOM MDS CE C5

45405-8 ABILITY TO UNDERSTAND OTHERS

FIND PT ^PATIENT NOM MDS CE C6

45406-6 CHANGE IN COMMUNICATION

&OR HEARING

FIND PT ^PATIENT NOM MDS CE C7

45994-1 VISION PATTERNS SECTION - PT ^PATIENT -

45407-4 VISION FIND PT ^PATIENT NOM MDS CE D1

45995-8 VISUAL LIMITATIONS AND DIFICULTIES

- PT ^PATIENT SET

45512-1 SIDE VISION PROBLEMS FIND PT ^PATIENT ORD MDS CE D2a 45513-9 SEES HALOS OR RINGS AROUND

LIGHTS, FLASHES OF LIGHT, OR CURTAINS OVER EYES

FIND PT ^PATIENT ORD MDS CE D2b

45514-7 NO VISUAL LIMITATIONS FIND PT ^PATIENT ORD MDS CE D2c 45515-4 VISUAL APPLIANCES FIND PT ^PATIENT ORD MDS CE D3 45996-6 MOOD AND BEHAVIOR

PATTERNS SECTION

- PT ^PATIENT -

45997-4 INDICATORS OF DEPRESSION, ANXIETY, SAD MOOD

- PT ^PATIENT SET

45998-2 VERBAL EXPRESSIONS OF DISTRESS

- PT ^PATIENT SET

45516-2 MAKES NEGATIVE STATEMENTS

FIND PT ^PATIENT NOM MDS CE E1a

45517-0 REPETITIVE QUESTIONS FIND PT ^PATIENT NOM MDS CE E1b 45518-8 REPETITIVE VERBALIZATIONS FIND PT ^PATIENT NOM MDS CE E1c 45519-6 PERSISTENT ANGER WITH SELF

OR OTHERS

FIND PT ^PATIENT NOM MDS CE E1d

45520-4 SELF DEPRECATION FIND PT ^PATIENT NOM MDS CE E1e 45521-2 EXPRESSION OF UNREALISTIC

FEARS

FIND PT ^PATIENT NOM MDS CE E1f

45522-0 RECURRENT STATEMENTS OF TERRIBLE FUTURE

FIND PT ^PATIENT NOM MDS CE E1g

45547-7 REPETITIVE HEALTH COMPLAINTS

FIND PT ^PATIENT NOM MDS CE E1h

45548-5 REPETITIVE ANXIOUS COMPLAINTS OR CONCERNS

FIND PT ^PATIENT NOM MDS CE E1i

45999-0 SLEEP-CYCLE ISSUES - PT ^PATIENT SET 45549-3 UNPLEASANT MOOD IN

MORNING

FIND PT ^PATIENT NOM MDS CE E1j

45550-1 INSOMNIA OR CHANGE IN SLEEPING PATTERN

FIND PT ^PATIENT NOM MDS CE E1k

46000-6 SAD, APETHETIC, ANXIOUS APPEARANCE

- PT ^PATIENT SET

45551-9 SAD, PAINED, OR WORRIED FACIAL EXPRESSIONS

FIND PT ^PATIENT NOM MDS CE E1l

45552-7 CRYING OR TEARFULNESS FIND PT ^PATIENT NOM MDS CE E1m 45553-5 REPETITIVE PHYSICAL

MOVEMENTS

FIND PT ^PATIENT NOM MDS CE E1n

46107-9 LOSS OF INTEREST - PT ^PATIENT SET 45554-3 WITHDRAWAL FROM

ACTIVITIES OF INTEREST

FIND PT ^PATIENT NOM MDS CE E1o

45555-0 REDUCED SOCIAL INTERACTION

FIND PT ^PATIENT NOM MDS CE E1p

45556-8 MOOD PERSISTENCE FIND PT ^PATIENT NOM MDS CE E2

45557-6 CHANGE IN MOOD FIND PT ^PATIENT NOM MDS CE E3

46001-4 BEHAVIORAL SYMPTOMS - PT ^PATIENT SET

45558-4 FREQUENCY OF WANDERING NRAT PT ^PATIENT QN MDS CE E4aA 45559-2 ALTERABILITY OF WANDERING FIND PT ^PATIENT ORD MDS CE E4aB 45560-0 FREQUENCY OF VERBALLY

ABUSIVE BEHAVIOR

NRAT PT ^PATIENT QN MDS CE E4bA

45561-8 ALTERABILITY OF VERBALLY ABUSIVE BEHAVIOR

FIND PT ^PATIENT ORD MDS CE E4bB

45562-6 FREQUENCY OF PHYSICALLY ABUSIVE BEHAVIOR

NRAT PT ^PATIENT QN MDS CE E4cA

45563-4 ALTERABILITY OF PHYSICALLY ABUSIVE BEHAVIOR

FIND PT ^PATIENT ORD MDS CE E4cB

45564-2 FREQUENCY OF SOCIALLY INAPPROPRIATE OR DISRUPTIVE BEHAVIOR

NRAT PT ^PATIENT QN MDS CE E4dA

45565-9 ALTERABILITY OF SOCIALLY INAPPROPRIATE OR DISRUPTIVE BEHAVIOR

FIND PT ^PATIENT ORD MDS CE E4dB

45566-7 FREQUENCY OF RESISTS CARE NRAT PT ^PATIENT QN MDS CE E4eA 45567-5 ALTERABILITY OF RESISTS

CARE

FIND PT ^PATIENT ORD MDS CE E4eB

45568-3 CHANGE IN BEHAVIORAL SYMPTOMS

FIND PT ^PATIENT NOM MDS CE E5

46002-2 PSYCHOSOCIAL WELL-BEING SECTION

- PT ^PATIENT -

46003-0 SENSE OF INITIATIVE AND INVOLVEMENT

- PT ^PATIENT SET

45569-1 AT EASE INTERACTING WITH OTHERS

FIND PT ^PATIENT ORD MDS CE F1a

45570-9 AT EASE DOING PLANNED OR STRUCTURED ACTIVITIES

FIND PT ^PATIENT ORD MDS CE F1b

45571-7 AT EASE DOING SELF-INITIATED ACTIVITIES

FIND PT ^PATIENT ORD MDS CE F1c

45572-5 ESTABLISHES OWN GOALS FIND PT ^PATIENT ORD MDS CE F1d 45573-3 PURSUES INVOLVEMENT IN

LIFE OF FACILITY

FIND PT ^PATIENT ORD MDS CE F1e

45574-1 ACCEPTS INVITATIONS TO MOST GROUP ACTIVITIES

FIND PT ^PATIENT ORD MDS CE F1f

45575-8 SENSE OF INITIATIVE - NONE OF ABOVE

FIND PT ^PATIENT ORD MDS CE F1g

46004-8 UNSETTLED RELEATIONSHIPS - PT ^PATIENT SET 45576-6 COVERT OR OPEN CONFLICT

WITH STAFF

FIND PT ^PATIENT ORD MDS CE F2a

45577-4 UNHAPPY WITH ROOMMATE FIND PT ^PATIENT ORD MDS CE F2b 45578-2 UNHAPPY WITH OTHER

RESIDENTS

FIND PT ^PATIENT ORD MDS CE F2c

45579-0 OPEN CONFLICT OR ANGER WITH FAMILY OR FRIENDS

FIND PT ^PATIENT ORD MDS CE F2d

45580-8 ABSENCE OF CONTACT WITH FAMILY OR FRIENDS

FIND PT ^PATIENT ORD MDS CE F2e

45581-6 RECENT LOSS OF FAMILY MEMBER OR FRIEND

FIND PT ^PATIENT ORD MDS CE F2f

45582-4 DOES NOT EASILY ADJUST TO ROUTINE CHANGE

FIND PT ^PATIENT ORD MDS CE F2g

45583-2 NO UNSETTLED RELATIONSHIPS

FIND PT ^PATIENT ORD MDS CE F2h

46005-5 PAST ROLES - PT ^PATIENT SET

45584-0 STRONG IDENTIFICATION WITH PAST ROLES AND LIFE STATUS

FIND PT ^PATIENT ORD MDS CE F3a

45585-7 SADNESS OR ANGER OVER LOST ROLES OR STATUS

FIND PT ^PATIENT ORD MDS CE F3b

45586-5 PERCEIVES THAT DAILY ROUTINE IS VERY DIFFERENT FROM PRIOR ACTIVITY

FIND PT ^PATIENT ORD MDS CE F3c

45587-3 PAST ROLES - NONE OF ABOVE FIND PT ^PATIENT ORD MDS CE F3d 46006-3 PHYSICAL FUNCTIONING AND

STUCTURAL PROBLEMS SECTION

- PT ^PATIENT SET

46007-1 ADL SELF PERFORMANCE OR SUPPORT

- PT ^PATIENT SET

45588-1 BED MOBILITY - SELF- PERFORMANCE

FIND PT ^PATIENT NOM MDS CE G1aA

45589-9 BED MOBILITY - SUPPORT PROVIDED

FIND PT ^PATIENT NOM MDS CE G1aB

45590-7 TRANSFER - SELF- PERFORMANCE

FIND PT ^PATIENT NOM MDS CE G1bA

45591-5 TRANSFER - SUPPORT PROVIDED

FIND PT ^PATIENT NOM MDS CE G1bB

45592-3 WALK IN ROOM - SELF- PERFORMANCE

FIND PT ^PATIENT NOM MDS CE G1cA

45593-1 WALK IN ROOM - SUPPORT PROVIDED

FIND PT ^PATIENT NOM MDS CE G1cB

45594-9 WALK IN CORRIDOR - SELF- PERFORMANCE

FIND PT ^PATIENT NOM MDS CE G1dA

45595-6 WALK IN CORRIDOR - SUPPORT PROVIDED

FIND PT ^PATIENT NOM MDS CE G1dB

45596-4 LOCOMOTION ON UNIT - SELF- PERFORMANCE

FIND PT ^PATIENT NOM MDS CE G1eA

45597-2 LOCOMOTION ON UNIT - SUPPORT PROVIDED

FIND PT ^PATIENT NOM MDS CE G1eB

45598-0 LOCOMOTION OFF UNIT - SELF- PERFORMANCE

FIND PT ^PATIENT NOM MDS CE G1fA

45599-8 LOCOMOTION OFF UNIT - SUPPORT PROVIDED

FIND PT ^PATIENT NOM MDS CE G1fB

45600-4 DRESSING - SELF- PERFORMANCE

FIND PT ^PATIENT NOM MDS CE G1gA

45601-2 DRESSING - SUPPORT PROVIDED

FIND PT ^PATIENT NOM MDS CE G1gB

45602-0 EATING - SELF-PERFORMANCE FIND PT ^PATIENT NOM MDS CE G1hA 45603-8 EATING - SUPPORT PROVIDED FIND PT ^PATIENT NOM MDS CE G1hB 45604-6 TOILET USE - SELF-

PERFORMANCE

FIND PT ^PATIENT NOM MDS CE G1iA

45605-3 TOILET USE - SUPPORT PROVIDED

FIND PT ^PATIENT NOM MDS CE G1iB

45606-1 PERSONAL HYGIENE - SELF- PERFORMANCE

FIND PT ^PATIENT NOM MDS CE G1jA

45607-9 PERSONAL HYGIENE - SUPPORT PROVIDED

FIND PT ^PATIENT NOM MDS CE G1jB

46008-9 BATHING - PT ^PATIENT SET

45608-7 BATHING - SELF- PERFORMANCE

FIND PT ^PATIENT NOM MDS CE G2A

45609-5 BATHING - SUPPORT PROVIDED FIND PT ^PATIENT NOM MDS CE G2B 46009-7 TEST FOR BALANCE - PT ^PATIENT SET

45610-3 BALANCE WHILE STANDING FIND PT ^PATIENT NOM MDS CE G3a 45523-8 BALANCE WHILE SITTING FIND PT ^PATIENT ORD MDS CE G3b 46010-5 FUNCTIONAL LIMITATION IN

RANGE OF MOTION

- PT ^PATIENT SET

45524-6 RANGE OF MOTION FIND PT NECK ORD MDS CE G4aA 45525-3 VOLUNTARY MOVEMENT FIND PT NECK ORD MDS CE G4aB 45526-1 RANGE OF MOTION FIND PT UPPER

EXTREMITY

ORD MDS CE G4bA

45527-9 VOLUNTARY MOVEMENT FIND PT UPPER EXTREMITY

ORD MDS CE G4bB

45528-7 RANGE OF MOTION FIND PT HAND ORD MDS CE G4cA 45529-5 VOLUNTARY MOVEMENT FIND PT HAND ORD MDS CE G4cB 45530-3 RANGE OF MOTION FIND PT LOWER

EXTREMITY

ORD MDS CE G4dA

45531-1 VOLUNTARY MOVEMENT FIND PT LOWER EXTREMITY

ORD MDS CE G4dB

45532-9 RANGE OF MOTION FIND PT FOOT ORD MDS CE G4eA 45533-7 VOLUNTARY MOVEMENT FIND PT FOOT ORD MDS CE G4eB 45534-5 OTHER - RANGE OF MOTION FIND PT ^PATIENT ORD MDS CE G4fA 45535-2 OTHER - VOLUNTARY

MOVEMENT

FIND PT ^PATIENT ORD MDS CE G4fB

46011-3 MODES OF LOCOMOTION - PT ^PATIENT SET 45536-0 USES CANE, WALKER OR

CRUTCH

FIND PT ^PATIENT ORD MDS CE G5a

45537-8 WHEELED SELF FIND PT ^PATIENT ORD MDS CE G5b 45538-6 OTHER PERSON WHEELED FIND PT ^PATIENT ORD MDS CE G5c 45539-4 USES WHEELCHAIR FOR

PRIMARY LOCOMOTION

FIND PT ^PATIENT ORD MDS CE G5d

45540-2 NO MODES OF LOCOMOTION FIND PT ^PATIENT ORD MDS CE G5e 46012-1 MODES OF TRANSFER - PT ^PATIENT SET

45541-0 BEDFAST ALL OR MOST OF THE TIME

FIND PT ^PATIENT ORD MDS CE G6a

45542-8 BED RAILS FOR BED MOBILITY OR TRANSFER

FIND PT ^PATIENT ORD MDS CE G6b

45543-6 LIFTED MANUALLY FIND PT ^PATIENT ORD MDS CE G6c 45544-4 LIFTED MECHANICALLY FIND PT ^PATIENT ORD MDS CE G6d 45545-1 TRANSFER AID FIND PT ^PATIENT ORD MDS CE G6e 45546-9 NO MODE OF TRANSFER FIND PT ^PATIENT ORD MDS CE G6f

45611-1 TASK SEGMENTATION FIND PT ^PATIENT ORD MDS CE G7 46013-9 ADL FUNCTIONAL

REHABILITATION POTENTIAL

- PT ^PATIENT SET

45612-9 RESIDENT SEES INCREASED INDEPENDENCE CAPABILITY

FIND PT ^PATIENT ORD MDS CE G8a

45613-7 STAFF SEES INCREASED INDEPENDENCE CAPABILITY

FIND PT ^PATIENT ORD MDS CE G8b

45614-5 RESIDENT SLOW PERFORMING TASKS OR ACTIVITY

FIND PT ^PATIENT ORD MDS CE G8c

45615-2 DIFFERENCE IN MORNING TO EVENING ACTIVITIES OF DAILY LIVING

FIND PT ^PATIENT ORD MDS CE G8d

45616-0 ACTIVITIES OF DAILY LIVING REHABILITATION POTENTIAL - NONE OF ABOVE

FIND PT ^PATIENT ORD MDS CE G8e

45617-8 CHANGE IN ACTIVITIES OF DAILY LIVING FUNCTION

FIND PT ^PATIENT NOM MDS CE G9

46014-7 CONTINENCE IN LAST 14 DAYS SECTION

- PT ^PATIENT SET

46015-4 CONTINENCE SELF-CONTROL CATEGORIES

- PT ^PATIENT SET

45619-4 BLADDER CONTINENCE FIND PT ^PATIENT NOM MDS CE H1b 45618-6 BOWEL CONTINENCE FIND PT ^PATIENT NOM MDS CE H1a 46016-2 BOWEL ELIMINATION PATTERN - PT ^PATIENT SET

45620-2 REGULAR BOWEL ELIMINATION

FIND PT ^PATIENT ORD MDS CE H2a

45621-0 CONSTIPATION FIND PT ^PATIENT ORD MDS CE H2b

45622-8 DIARRHEA FIND PT ^PATIENT ORD MDS CE H2c

45623-6 FECAL IMPACTION FIND PT ^PATIENT ORD MDS CE H2d 45624-4 BOWEL ELIMINATION PATTERN

- NONE OF ABOVE

FIND PT ^PATIENT ORD MDS CE H2e

46017-0 CONTINENCE APPLIANCES AND PROGRAMS

- PT ^PATIENT SET

45625-1 SCHEDULED TOILETING PLAN FIND PT ^PATIENT ORD MDS CE H3a 45626-9 BLADDER RETRAINING

PROGRAM

FIND PT ^PATIENT ORD MDS CE H3b

45627-7 EXTERNAL CATHETER FIND PT ^PATIENT ORD MDS CE H3c 45628-5 INDWELLING CATHETER FIND PT ^PATIENT ORD MDS CE H3d 45629-3 INTERMITTENT CATHETER FIND PT ^PATIENT ORD MDS CE H3e 45630-1 DID NOT USE TOILET &OR

COMMODE &OR URINAL

FIND PT ^PATIENT ORD MDS CE H3f

45631-9 PADS &OR BRIEFS USED FIND PT ^PATIENT ORD MDS CE H3g 45632-7 ENEMAS & OR IRRIGATION FIND PT ^PATIENT ORD MDS CE H3h 45633-5 OSTOMY PRESENT FIND PT ^PATIENT ORD MDS CE H3i 45634-3 CONTINENCE APPLIANCES AND

PROGRAMS - NONE OF ABOVE

FIND PT ^PATIENT ORD MDS CE H3j

45635-0 CHANGE IN URINARY CONTINENCE

FIND PT ^PATIENT NOM MDS CE H4

46018-8 DISEASE DIAGNOSIS SECTION - PT ^PATIENT -

46019-6 DISEASES - PT ^PATIENT SET

46020-4 ENDOCRINE, METABOLIC OR NUTRITIONAL DISEASES

- PT ^PATIENT SET

45636-8 DIABETES MELLITUS FIND PT ^PATIENT ORD MDS CE I1a 45637-6 HYPERTHYROIDISM FIND PT ^PATIENT ORD MDS CE I1b 45638-4 HYPOTHYROIDISM FIND PT ^PATIENT ORD MDS CE I1c 46021-2 HEART OR CIRCULATION

DISEASES

- PT ^PATIENT SET

45639-2 ARTERIOSCLEROTIC HEART DISEASE

FIND PT ^PATIENT ORD MDS CE I1d

45640-0 CARDIAC DYSRHYTHMIAS FIND PT ^PATIENT ORD MDS CE I1e 45641-8 CONGESTIVE HEART FAILURE FIND PT ^PATIENT ORD MDS CE I1f 45642-6 DEEP VEIN THROMBOSIS FIND PT ^PATIENT ORD MDS CE I1g 45643-4 HYPERTENSION FIND PT ^PATIENT ORD MDS CE I1h 45644-2 HYPOTENSION FIND PT ^PATIENT ORD MDS CE I1i 45645-9 PERIPHERAL VASCULAR

DISEASE

FIND PT ^PATIENT ORD MDS CE I1j

45646-7 OTHER CARDIOVASCULAR DISEASE

FIND PT ^PATIENT ORD MDS CE I1k

46022-0 MUSCULOSKELETAL DISEASES - PT ^PATIENT SET

45647-5 ARTHRITIS FIND PT ^PATIENT ORD MDS CE I1l 45648-3 HIP FRACTURE FIND PT ^PATIENT ORD MDS CE I1m 45649-1 MISSING LIMB FIND PT ^PATIENT ORD MDS CE I1n 45650-9 OSTEOPOROSIS FIND PT ^PATIENT ORD MDS CE I1o 45651-7 PATHOLOGICAL BONE

FRACTURE

FIND PT ^PATIENT ORD MDS CE I1p

46023-8 NEUROLOGICAL DISEASES - PT ^PATIENT SET

45652-5 ALZHEIMER'S DISEASE FIND PT ^PATIENT ORD MDS CE I1q 45653-3 APHASIA FIND PT ^PATIENT ORD MDS CE I1r 45654-1 CEREBRAL PALSY FIND PT ^PATIENT ORD MDS CE I1s 45655-8 CEREBROVASCULAR ACCIDENT FIND PT ^PATIENT ORD MDS CE I1t 45656-6 DEMENTIA OTHER THAN

ALZHEIMER'S

FIND PT ^PATIENT ORD MDS CE I1u

45657-4 HEMIPLEGIA OR HEMIPARESIS FIND PT ^PATIENT ORD MDS CE I1v 45658-2 MULTIPLE SCLEROSIS FIND PT ^PATIENT ORD MDS CE I1w 45659-0 PARAPLEGIA FIND PT ^PATIENT ORD MDS CE I1x 45660-8 PARKINSON'S DISEASE FIND PT ^PATIENT ORD MDS CE I1y 45661-6 QUADRIPLEGIA FIND PT ^PATIENT ORD MDS CE I1z 45662-4 SEIZURE DISORDER FIND PT ^PATIENT ORD MDS CE I1aa 45663-2 TRANSIENT ISCHEMIC ATTACK FIND PT ^PATIENT ORD MDS CE I1bb 45664-0 TRAUMATIC BRAIN INJURY FIND PT ^PATIENT ORD MDS CE I1cc 46024-6 PSYCHIATRIC OR MOOD

DISORDERS

- PT ^PATIENT SET

45665-7 ANXIETY DISORDER FIND PT ^PATIENT ORD MDS CE I1dd 45666-5 DEPRESSION FIND PT ^PATIENT ORD MDS CE I1ee 45667-3 MANIC DEPRESSIVE FIND PT ^PATIENT ORD MDS CE I1ff 45668-1 SCHIZOPHRENIA FIND PT ^PATIENT ORD MDS CE I1gg 46025-3 PULMONARY DISEASES - PT ^PATIENT SET

45669-9 ASTHMA FIND PT ^PATIENT ORD MDS CE I1hh 45670-7 EMPHYSEMA OR COPD FIND PT ^PATIENT ORD MDS CE I1ii 46026-1 SENSORY DISEASES - PT ^PATIENT SET

45671-5 CATARACTS FIND PT ^PATIENT ORD MDS CE I1jj 45672-3 DIABETIC RETINOPATHY FIND PT ^PATIENT ORD MDS CE I1kk 45673-1 GLAUCOMA FIND PT ^PATIENT ORD MDS CE I1ll 45674-9 MACULAR DEGENERATION FIND PT ^PATIENT ORD MDS CE I1mm 46027-9 OTHER DISEASES - PT ^PATIENT SET

45675-6 ALLERGIES FIND PT ^PATIENT ORD MDS CE I1nn 45676-4 ANEMIA FIND PT ^PATIENT ORD MDS CE I1oo 45677-2 CANCER FIND PT ^PATIENT ORD MDS CE I1pp 45678-0 RENAL FAILURE FIND PT ^PATIENT ORD MDS CE I1qq 45679-8 DISEASES - NONE OF ABOVE FIND PT ^PATIENT ORD MDS CE I1rr

46028-7 INFECTIONS - PT ^PATIENT SET

45680-6 INFECTION WITH ANTIBIOTIC RESISTANT ORGANISM

FIND PT ^PATIENT ORD MDS CE I2a

45681-4 INFECTION WITH CLOSTRIDIUM DIFFICILE

FIND PT ^PATIENT ORD MDS CE I2b

45682-2 CONJUNCTIVITIS FIND PT ^PATIENT ORD MDS CE I2c 45683-0 HIV INFECTION FIND PT ^PATIENT ORD MDS CE I2d

45684-8 PNEUMONIA FIND PT ^PATIENT ORD MDS CE I2e

45685-5 RESPIRATORY TRACT INFECTION

FIND PT ^PATIENT ORD MDS CE I2f

45686-3 SEPTICEMIA FIND PT ^PATIENT ORD MDS CE I2g 45687-1 SEXUALLY TRANSMITTED

DISEASE

FIND PT ^PATIENT ORD MDS CE I2h

45688-9 TUBERCULOSIS FIND PT ^PATIENT ORD MDS CE I2i 45689-7 URINARY TRACT INFECTION IN

LAST 30 DAYS

FIND PT ^PATIENT ORD MDS CE I2j

45690-5 VIRAL HEPATITIS FIND PT ^PATIENT ORD MDS CE I2k 45691-3 WOUND INFECTION FIND PT ^PATIENT ORD MDS CE I2l 45692-1 INFECTIONS - NONE OF ABOVE FIND PT ^PATIENT ORD MDS CE I2m 46029-5 OTHER CURRENT OR MORE

DETAILED DIAGNOSIS & ICD9 CODES

- PT ^PATIENT SET

45693-9 OTHER CURRENT OR MORE DETAILED DIAGNOSIS & ICD9 CODES

PRID PT ^PATIENT NOM MDS TX I3a

45958-6 OTHER CURRENT OR MORE PRID PT ^PATIENT NOM MDS TX I3b

DETAILED DIAGNOSIS & ICD9 CODES^^^2

45959-4 OTHER CURRENT OR MORE DETAILED DIAGNOSIS & ICD9 CODES^^^3

PRID PT ^PATIENT NOM MDS TX I3c

45960-2 OTHER CURRENT OR MORE DETAILED DIAGNOSIS & ICD9 CODES^^^4

PRID PT ^PATIENT NOM MDS TX I3d

45961-0 OTHER CURRENT OR MORE DETAILED DIAGNOSIS & ICD9 CODES^^^5

PRID PT ^PATIENT NOM MDS TX I3e

46030-3 HEALTH CONDITIONS SECTION - PT ^PATIENT - 46105-3 PROBLEM CONDITIONS - PT ^PATIENT SET 46031-1 INDICATORS OF FLUID STATUS - PT ^PATIENT SET 45694-7 WEIGHT FLUCTUATION 3+ LBS.

IN 7 DAYS

FIND PT ^PATIENT ORD MDS CE J1a

45695-4 INABILITY TO LIE FLAT DUE TO SHORTNESS OF BREATH

FIND PT ^PATIENT ORD MDS CE J1b

45696-2 DEHYDRATED FIND PT ^PATIENT ORD MDS CE J1c 45697-0 INSUFFICIENT FLUID IN LAST 3

DAYS

FIND PT ^PATIENT ORD MDS CE J1d

46032-9 OTHER INDICATORS - PT ^PATIENT SET

45698-8 DELUSIONS FIND PT ^PATIENT ORD MDS CE J1e 45699-6 DIZZINESS OR VERTIGO FIND PT ^PATIENT ORD MDS CE J1f 45700-2 EDEMA FIND PT ^PATIENT ORD MDS CE J1g 45701-0 FEVER FIND PT ^PATIENT ORD MDS CE J1h 45702-8 HALLUCINATIONS FIND PT ^PATIENT ORD MDS CE J1i 45703-6 INTERNAL BLEEDING FIND PT ^PATIENT ORD MDS CE J1j 45704-4 RECURRENT LUNG

ASPIRATIONS IN LAST 90 DAYS

FIND PT ^PATIENT ORD MDS CE J1k

45705-1 SHORTNESS OF BREATH FIND PT ^PATIENT ORD MDS CE J1l 45706-9 SYNCOPE FIND PT ^PATIENT ORD MDS CE J1m 45707-7 UNSTEADY GAIT FIND PT ^PATIENT ORD MDS CE J1n 45708-5 VOMITING FIND PT ^PATIENT ORD MDS CE J1o 45709-3 PROBLEM CONDITIONS - NONE

OF ABOVE

FIND PT ^PATIENT ORD MDS CE J1p

46033-7 PAIN SYMPTOMS - PT ^PATIENT SET

45710-1 PAIN FREQUENCY NRAT PT ^PATIENT NOM MDS CE J2a 45711-9 PAIN INTENSITY FIND PT ^PATIENT ORD MDS CE J2b

46034-5 PAIN SITE - PT ^PATIENT SET

45712-7 BACK PAIN FIND PT ^PATIENT ORD MDS CE J3a

45713-5 BONE PAIN FIND PT ^PATIENT ORD MDS CE J3b

45714-3 CHEST PAIN DURING USUAL ACTIVITIES

FIND PT ^PATIENT ORD MDS CE J3c

45715-0 HEADACHE FIND PT ^PATIENT ORD MDS CE J3d

45716-8 HIP PAIN FIND PT ^PATIENT ORD MDS CE J3e

45717-6 INCISIONAL PAIN FIND PT ^PATIENT ORD MDS CE J3f 45718-4 JOINT PAIN FIND PT ^PATIENT ORD MDS CE J3g 45719-2 SOFT TISSUE PAIN FIND PT ^PATIENT ORD MDS CE J3h 45720-0 STOMACH PAIN FIND PT ^PATIENT ORD MDS CE J3i 45721-8 OTHER PAIN FIND PT ^PATIENT ORD MDS CE J3j

46035-2 ACCIDENTS - PT ^PATIENT SET

45722-6 FELL IN PAST 30D FIND PT ^PATIENT ORD MDS CE J4a 45723-4 FELL IN PAST 31D-180D FIND PT ^PATIENT ORD MDS CE J4b 45724-2 HIP FRACTURE IN LAST 180D FIND PT ^PATIENT ORD MDS CE J4c 45725-9 OTHER FRACTURE IN LAST

180D

FIND PT ^PATIENT ORD MDS CE J4d

45726-7 ACCIDENTS - NONE OF ABOVE FIND PT ^PATIENT ORD MDS CE J4e 46036-0 STABILITY OF CONDITIONS - PT ^PATIENT SET

45727-5 CONDITIONS OR DISEASES LEAD TO INSTABILITY

FIND PT ^PATIENT ORD MDS CE J5a

45728-3 EXPERIENCING ACUTE EPISODE OR FLARE-UP OF RECURRENT OR CHRONIC PROBLEM

FIND PT ^PATIENT ORD MDS CE J5b

45729-1 END-STAGE DISEASE FIND PT ^PATIENT ORD MDS CE J5c 45730-9 STABILITY OF CONDITIONS -

NONE OF ABOVE

FIND PT ^PATIENT ORD MDS CE J5d

46037-8 ORAL AND NUTRITIONAL - PT ^PATIENT -